Hi All. Newbie here....this is my first post. A friend from another site said that maybe I could find some help here. I'm 38 weeks pregnant with my second child, and I have a low placenta, and I'm trying to avoid C section if I can do so without taking irresponsible risks. I tend to go on and on and on when I post, so I'm going to try to keep this short and to the point.
-I live in Athens, Greece. We have an out-of-control C section rate here, an awful induction rate, and a "don't question the doctor" culture. (My husband is Greek. I am American.)
-My first baby, born 2.5 years ago, was 9 lbs even, induced, born 6 hours exactly after the pit IV was put in my arm. (Induced because my doctor had another patient delivering that night--I was 2 days overdue, not in labor at.all.) Uncomplicated vaginal delivery--but a huuuuuuge episiotomy (doc didn't even *tell* me she was cutting it....but that's another post).
-With this pregnancy, I wanted a totally different experience--no epidural, NO INDUCTION. I would love a homebirth but when I mentioned it to my husband his head nearly exploded. I chose a natural birth clinic, the only one in Greece, which is part of an older maternity clinic which can do C sections but apparently is not equipped to do blood transfusions. I've had a completely uncomplicated pregnancy--I've never even thrown up.
-At 22 weeks, ultrasound revealed that my placenta was touching my cervix, but the doctor assured me that it would "move up". (I've read as much as I can about this, I know they don't actually move, just appear to as the uterus grows.)
-At 32 weeks, ultrasound (transabdominal) revealed that the placenta was 2.3 cm from the cervical os. Ultrasound doc said don't panic, it still has time to move, see what your OB says at 36 weeks.
-At 36 weeks, my OB (Dr. Bilalis), whom I chose because he's supposed to be natural-birth friendly and delivers at the natural birth clinic (which is considered very VERY treehuggerfringe by the Greek mainstream), made a face at the 2.3cm measurement and said we'll see if it has moved, but it doesn't look good, and if it hasn't moved it looks like C. He has an ultrasound machine in his office, and with trans-vaginal ultrasound measured 2.4 cm. Seemed very pessimistic and said he'd see me in 2 weeks but if it hadn't moved he thought we should schedule C in the 39th week. He pretty much terrified my husband, telling him that if I hemorrhage it could be really, really bad, and that it is a good thing that we're 15 minutes from his hospital, and that the first sign of ANY blood I needed to get to the hospital.
-I've done a lot of reading about placenta previa and low lying placenta since the 32 week ultrasound, and I knew already that many articles say that if the placenta is more than 2 cm from the cervical os, a trial of vaginal labor stands a good chance (greater than 60% in some articles, just "good chance" in others) of success. I wanted to line up some second opinions since this doc seemed SO negative.
-I spoke over the phone to one doc who knows my doc---he said he'd allow a trial of labor in my case but that he really respects my doc, good training (in the UK--they trained there together), etc etc, and I should go back to my doc and present my concerns, blah blah. Basically I think he wouldn't take me as a patient because of a professional relationship with my doc.
-I spoke over the phone with another doc, a German woman much-respected in the expat circles here, who apparently does VBACs (and thus isn't totally risk-averse, at least not by Greek standards). She said she'd do a C for anything under 5cm, totally validating *my* doc's position.
-At 37 weeks 1 day, I met with yet another doc (Dr. Kalabani), who was recommended to me by one of the midwives who works at the natural birth clinic. She said 2.4cm "is not a problem". She wanted to meet with me, though, and do yet another ultrasound. We met with her and she was very reassuring. They did the ultrasound (trans-abdominal, which I understand is less accurate than trans-vaginal), and measured the distance at 4cm (just 1 week 1 day after the 2.4 trans-vag measurement with Dr. Bilalis). They said the placenta was "far away", that anything over 2 cm was OK, and that the baby's head was below the edge of the placenta. Dr. Kalabani said I should expect to deliver in the hospital, not the natural birth clinic, as the hospital is better equipped in CASE things turn ugly, but that she saw no reason for me to expect anything other than a successful vaginal delivery. She said that as the baby's head descends, it would cut off any bleeding, and she wasn't worried about hemorrhage.
-Last night, at 37 weeks 6 days, we went back to Dr. Bilalis. I wanted to get a better understanding of the risks of hemorrhage, see if he would back off on the C section if I told him about all that I'd read and that I wanted a trial of labor. Before we had any discussions, he repeated the trans-vaginal ultrasound, and said "it hadn't moved since 32 weeks". I said, what is the distance? He said, 2.3, 2.4 cm. He said the placenta (anterior placenta) was between the baby's head and the cervical os. Then I gave him my spiel about what I'd read, about the fact that I'm American and Americans seek second opinions on serious issues, told him about my discussions with other doctors, told him about the other ultrasound with the 4cm measurement, told him about the medical articles I'd found that repeatedly say that with more than 2 cm, a trial of labor is appropriate. He asked who the patients were in these studies, so I brought out printouts with what I saw as the relevant bits highlighted. He told me he'd "allow" me to go to 40 weeks, on the off chance I went into labor, which he didn't think would happen as the placenta would prevent the baby's head from descending. He said that if the placenta was posterior, it might be different, but with an anterior placenta that he didn't think the baby's head would descend. He told me the "right" thing to do was to schedule the C section for next week, but that he'd "allow" me to go to 40 weeks, but not one day over: "I won't even discuss it." He repeated all that he'd said previously about how I was at risk of serious hemorrhage in which 5 minutes could make a difference, and I could die, blah blah blah. This has all really sunk into my husband's head, and in spite of hearing the exact opposite from Dr. Kalabani not even a week ago, he is *freaked* out and I know he basically wishes I'd do the C next week. I'm not typing it all out here but the conversation with Dr. Bilalis got really ugly. Doctors in Greece are not used to being questioned by patients and it quickly degenerated into him telling me that "now you're just fantasizing that you don't have this complication", calling every point I made in my questions "invalid", refusing to discuss the conditions of vaginal birth at his hospital (the one where he does most deliveries, since most Greek women won't do the no-epi natural birth center, and the hospital where my daughter was born--where you are only permitted to labor and deliver flat on your back, etc) because there was a ".001% chance of vaginal delivery", "well I guess you know more than I do, why don't you go find a hospital that has policies you approve of and a doctor who will tell you things you want to hear". My husband says there was yelling on both sides, but I had planned this conversation in my head and was actively trying to keep it from getting too confrontational.....it was awful. Really awful. As soon as I was out of the office, I lost it, and I pretty much cried for the rest of the night.
-My husband has tried to appear sympathetic, but Dr. Bilalis has scared the proverbial sht out of him....what he really wants me to do is give in and schedule the C.
-What I really want to do is have my trial of labor with Dr. Kalabani, at *her* hospital, which is more labor-friendly and has birth pools, etc. But Dr. Bilalis has scared me with his horror stories, too.
-Mitera (Dr. Bilalis' hospital), is about 15 min drive from our house. Lito (Dr. Kalabani's hospital) is about 30-40 minutes drive, maybe worse with traffic which can be awful and unpredictable here.
So, if you've read through ALLLL that, thank you sooo much. What I need help with is understanding the risk I'm taking if I go with the trial of vaginal delivery with Dr. Kalabani at Lito. Is the extra 20 minutes distance to the hospital critical? What am I *really* risking, if I start to hemorrhage at home? What are the chances of this? I've heard the bleeding can be really really bad......but I've heard this from the 2 doctors that would go to C immediately in my case. What am I risking? I don't want to take irresponsible risks. I look at my little girl, and I really don't want to bleed to death....the idea of leaving her motherless gives me a bigger push toward that C than anything else. But....I don't want to live the rest of my life wondering if everything with this birth would have gone just fine if I'd just let nature take its course, either.
Does anyone have real life experience with a situation like mine? Can anyone give me advice, or tell me anything more about how real the risk of hemorrhage is for me? And how bad the hemorrhage could be?
Thanks so much to anyone who can help me with this. It's been an awful two weeks for me. I just wanted this birth to be so different from this.....